The most wide spread single use circumcision device currently in use is marketed under the trademark PLASTIBELL. The PLASTIBELL device has a domed plastic ring with a frangible handle, and is available in six sizes. To use the PLASTIBELL device, the adhesions between the glans and foreskin are divided with a probe and the foreskin is then cut longitudinally to allow it to be retracted to expose the glans. The appropriate sized PLASTIBELL device is then selected and the ring applied to the head of the penis. The ring is then covered over by the foreskin and a ligature is tied firmly around the foreskin, which crushes the skin against the ring. The excess skin protruding beyond the ring is then trimmed off. To end the circumcision procedure, the handle is broken off the ring. The ring typically falls off in three to seven days leaving a circumferential wound that heals over the following week.
The PLASTIBELL device has several disadvantages. Firstly, the glans is unprotected during the circumcision procedure. As the ligature which is used to secure the foreskin must be tight, any slippage can cause injury to the glans.
Secondly, once the PLASTIBELL device is in place and the foreskin is clamped thereto, it is extremely difficult, due to a lack of visibility, to determine where the ring begins and where the glans ends. This is due to the foreskin covering the majority of the ring. This makes it difficult for the surgeon to perform the circumcision as it leads to difficulty in locating the area in which to tie the ligature. This in turn may lead to injury such as urethrocutaneous fistulae, extensive skin loss, dysuria, or ischemic necrosis.
Thirdly, once the PLASTIBELL device is in place, it governs how much of the foreskin may be removed. This is because the glans is pressed up against the ring, which blocks the glans from moving through the ring any further. This can result in only a limited, often less than ideal, amount of foreskin being able to be removed.